Percutaneous access for procedures in body lumens such as blood vessels is desirable to minimize complications from surgical procedures. Procedures using percutaneous access are also referred to as minimally invasive procedures. Many percutaneous procedures involving the aorta, coronary arteries, or other vessels near the heart rely on percutaneous access via the femoral artery. Access via the femoral artery is preferred for transcatheter aortic valve implantation (TAVI) procedures since it enables the clinician to routinely perform the procedure percutaneously. The subclavian/axillary artery is considered a backup access site when the femoral artery and/or associated pathway to the aortic valve precludes delivery due to tortuosity, heavy calcification, and/or vascular disease. The subclavian/axillary artery is a backup access site since it generally requires a surgical cutdown procedure, unlike the femoral artery which can be accessed percutaneously. In other ways, however, subclavian artery access for a TAVI procedure has distinct advantages over a TAVI procedure using femoral access. For example, and not by way of limitation, subclavian artery access for TAVI procedures allows for better control of the delivery catheter and the bioprosthesis during delivery. Subclavian artery access for TAVI procedures also eliminates the need for any groin sticks since all intervention can be accomplished above the waist. This latter advantage enables patients to potentially become mobile sooner than with the femoral access procedures. Disadvantages of subclavian access for procedures include difficulty in accessing and closing the subclavian artery that is significantly less superficially located (i.e., deeper) than the femoral artery. As noted above, accessing the subclavian artery normally requires a surgical cut-down procedure. Also, while the access point to the femoral artery can normally be closed by compression (such as a weight placed in the access region), access to the subclavian artery cannot be closed with compression due to the depth of the artery and the location of the clavicle. Thus, a surgical technique is normally required to close the access point of the subclavian artery, such as the use sutures to close the access hole/arteriotomy.
Accordingly, it would be desirable to provide percutaneous access to the subclavian artery in order to take advantage of the advantages provided by access via the subclavian artery while eliminating the disadvantages due to the current lack of percutaneous access via the subclavian artery and difficulties in closing access to the subclavian artery. Facilitating a percutaneous subclavian/axillary artery access for TAVI procedures may result in improved TAVI outcomes as well as providing an even more competitive alternative for sites performing transapical TAVI procedures.